Provider Demographics
NPI:1649424425
Name:LIFETIME PHYSICAL THERAPY AND FITNESS INC
Entity Type:Organization
Organization Name:LIFETIME PHYSICAL THERAPY AND FITNESS INC
Other - Org Name:LIFETIME HOME HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:714-980-1835
Mailing Address - Street 1:5072 STONE CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4313
Mailing Address - Country:US
Mailing Address - Phone:714-980-1835
Mailing Address - Fax:714-701-0814
Practice Address - Street 1:5072 STONE CANYON AVE
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4313
Practice Address - Country:US
Practice Address - Phone:714-980-1835
Practice Address - Fax:714-701-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health